| Corwin Oswald Demattos, | |
|
1637 Atlanta Hwy Suite A, Grayson, GA 30017-3001 | |
| (678) 344-8268 | |
| Not Available |
| Full Name | Corwin Oswald Demattos |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner - Family |
| Location | 1637 Atlanta Hwy Suite A, Grayson, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720617756 | NPI | - | NPPES |
| 054674999 | Other | GA | GEORGIA IDENTIFICATION CARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 189365 (Georgia) | Primary |
| Entity Name | North Atlanta Professional Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316959869 PECOS PAC ID: 0840291944 Enrollment ID: O20070116000197 |
| Mailing Address | Practice Location Address |
|---|---|
| Corwin Oswald Demattos, 1637 Atlanta Hwy Suite A, Grayson, GA 30017-5942 Ph: (678) 344-8268 | Corwin Oswald Demattos, 1637 Atlanta Hwy Suite A, Grayson, GA 30017-3001 Ph: (678) 344-8268 |
Mrs. Larresia Hairston Williamson, RN, MSN, FNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 413 Silvertop Dr, Grayson, GA 30017 Phone: 678-458-1877 | |
Miss Pamela Amelia Boyd, MS, APRN, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2594 Loganville Hwy Ste 101, Grayson, GA 30017 Phone: 678-225-4999 Fax: 678-225-5546 | |
Laqunita Smith, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2126 Leafmore Ct, Grayson, GA 30017 Phone: 770-339-3005 Fax: 770-339-3005 | |
Chidinma Anuliekette, AGACNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1098 Winding Down Way, Grayson, GA 30017 Phone: 404-200-3670 | |
Ancy Bobby, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 2530 Wevok Way, Grayson, GA 30017 Phone: 678-237-3220 | |
Alexis Maria Joseph, PMHNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 288 Sweet Cane Trl, Grayson, GA 30017 Phone: 470-819-7947 | |
Mrs. Ester Teresa Pulliam, PMHNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1637 Athens Hwy, Grayson, GA 30017 Phone: 678-344-8268 Fax: 888-627-6444 |